Isn’t this all just a bit “touchy-feely”?

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Questions from the sceptics:  1.  Isn’t this all a bit touchy-feely?

This is the first in a series of blog posts, reflecting on some of the comments we hear about Learning from Excellence.  This one is from Emma Plunkett

I talk about Learning from Excellence (LfE) a lot these days. I’ve presented the concept and the practicalities of the initiative at many different local, regional and national meetings and am generally met with a positive response. People can usually see the value in having a system for acknowledging and appreciating the work of colleagues. In addition, more people are becoming aware of the concept of safety-2 and understand the importance of learning from when things go right.

But naturally, as with any new idea, there are sceptics. Some people just don’t get it. Or maybe they can’t. One of the recent questions I have had from people struggling to understand the point of the initiative has been, “Isn’t this all just a bit touchy-feely?” When people have a really different perspective from mine, I try to understand their paradigm. I’ve found it hard this time, perhaps because the question came after a presentation describing all the uses of LfE (that’s another blog in itself). I find it hard to understand why someone wouldn’t agree that excellent work is to be appreciated, valued and investigated, so we can make more of it happen.

I’ve been thinking about how I should answer this if it comes up again and I’ve realised that my problem with the question is twofold. Firstly it’s the negative connotations associated with the phrase “touchy-feely”, which is often used to belittle the importance of emotional connections. It’s strange how a positive initiative can be “touchy-feely” in a somewhat undesirable way, whereas something with negative emotional consequences would never be described like that (or at least I hope it wouldn’t). Why can’t we equally value positive interactions? And not dismiss them as something sentimental that carries less value. It also implies that the praise is unrestrained or overstated. Importantly, this is not the case with LfE. The honest and sincere nature of the reports we see is key to their value; exaggerated or artificial praise becomes patronising and does not work, and LfE is not about this.

My second problem is with the word “just”. There are elements to the initiative which are deliberately and importantly emotional. But there is much more to it. “Just” in this context represents an excuse to dismiss LfE as something trivial and although some reports are about small events, all of them have made a difference to the people involved, and none of them should be rejected as inconsequential. LfE can’t be pigeon-holed into being “just” one thing – it is about reflection, appreciation, improving morale, improving quality, service development and creating a culture of learning.

For me, work is made worthwhile through connecting with others, be they patients, relatives, or colleagues, and making a difference to their lives. LfE involves showing genuine gratitude for the work of others, enabling a positive connection to form. Success at work also relies upon constantly learning, developing and improving and helping others to do the same. Learning from what we have done and using it to inform our future decisions. These are the key principles behind LfE.

So how will I answer the question next time? I think I will try to explore what is meant by “touchy-feely”. If it means insincere or inappropriate, effusive sentimentality , then that is not what LfE is about. But I’m not going to pretend that LfE doesn’t involve expressing positive emotions. It’s one of the keys to its success. And if that’s what being touchy-feely is, then yes it is a bit, and that’s why it works.

 

Dr Emma Plunkett

Focus on excellence

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Today’s blog post is from Dr Nicki Kelly: @nickik_

On any journey, to reach your destination safely and promptly, you need to look toward the direction in which you are heading. To aim for top quality safe healthcare, surely we need to fix our eyes and our focus on the excellent, rather than only looking back on failure or being distracted by negative things.

How interesting then, that our industry strives for safety and quality by focusing on occurrences where it absent. Is that not like trying to become a world-class athlete by only observing the technique and performance of those who lose the race?

I’m sure we all witness clinical excellence every single day, yet error and failures seem to monopolise our attention and the media spotlight. We may be missing the opportunity to celebrate, share and learn from excellence in the wider NHS.

Do you need to reduce distractions on your route to clinical excellence, and focus your mind on those things that are excellent and recognise practices worthy of praise? The Learning from Excellence initiative may provide the inspiration to help keep you on the right track.

 

The soft stuff is the hard stuff

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So, we have a bias towards negativity: we see error without trying, and we have a preference to criticise and focus on others’ errors and misfortunes.  If you don’t believe me, check out the most read news stories on any ‘news’ media source and count the ratio of negative to positive stories. Hardly reflective of reality is it? Click here for the BBC most read stories today.  While I’m on the subject, I should also point you to Kahneman’s work on loss aversion. We value loss more than the equivalent amount of gain. Weird but true.

But here’s a paradox: it’s actually easier to give sincere praise than criticism. It takes less effort, and it makes us feel better (both giving and receiving). This is especially true in face to face encounters.

So what does this mean for patient safety? In my opinion the “safety 1” culture (reacting to error and harm) has got out of hand. Learning from error is important but the agenda is being driven by a ‘movement’ which gives no acknowledgement to loss aversion. Mistakes happen, and will always happen. But it is time to attribute the correct value to them and to acknowledge the value of excellence. Then we may be able to open the doors to the immensely fruitful study of learning from what goes well.

Safety 2 is a great start. Read about it here. But where are the tools to use this approach? Learning from Excellence  (or positive event reporting in any form) is our offering.

In case you think this is all a bit ‘soft’, consider this: doctors and nurses are leaving their jobs, getting sick and killing themselves.  So I would argue that the ‘soft’ stuff is the ‘hard’ stuff.

Why all the negativity?

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We have an innate negativity bias.  Our ancestors survived, in part, because of their ability to spot inconsistencies.  Our sense-making, automatic brain is excellent at spotting patterns, and inconsistencies in those patterns.  This happens before our conscious brain is even made “aware”.  This means that, most of the time, we can’t stop ourselves spotting mistakes.  Therefore we have to look a little harder at our world to spot excellence.  This bias may have helped our ancestors survive, but it is probably not helpful for our organisations.  It takes a slight, but significant, change of mindset to start actively noticing excellence to the point where we can capture it.

So, I urge you to take the plunge and start looking intently for excellence.  When you see it (and you will!), please take the time to inform the individual or team who performed it.